Orlaith Quinn was an outgoing, vivacious mother of two until halfway through her third pregnancy, when she became uncharacteristically withdrawn. She raised her anxiety in checkups, but doctors told her this was normal. When she became manic after giving birth and told her family she had tried to kill herself three times, she was assessed by a psychiatrist who determined she was not a suicide risk.
Quinn had developed postpartum psychosis, which has good recovery rates, but an inquest determined earlier this year that her death in late 2018 at Belfast’s Royal Jubilee maternity hospital was “both foreseeable and preventable”.
Her husband, Ciaran, believes that if the hospital had a specialist mother and baby unit, “the culture in the hospital would have been different”, and staff would have been more aware of and experienced in dealing with perinatal and postnatal mental health problems.
“It’s an absolute crime Northern Ireland doesn’t have a mother and baby unit – there are various in England, Wales and now Scotland. Why did the women here not have that service – why should women here suffer? Why are they not treated as equal? Why don’t they have the same services when we’re governed by the same people? It blows my socks off,” he said.
The number of women dying in pregnancy or shortly after giving birth in the UK has risen sharply, with women three times more likely to die around the time of pregnancy compared with those in Norway. Suicide is the leading cause, accounting for 18% of deaths, and the WHO has now warned that the cost of living crisis is exacerbating the picture.
A coroner ruled that there had been multiple failings in the hospital’s handling of Quinn’s case: she was diagnosed with obsessional neurosis, although the psychiatrist noted that postpartum psychosis couldn’t be ruled out. Despite this, she was not given medication or moved to a psychiatric ward, and was left unsupervised in a room.
The impact of Orlaith’s death on the Quinns has been devastating. “The grief completely consumed me and overwhelmed every cell of my body to the point I couldn’t function day to day,” said Ciaran. “The nature of her death, how quickly it happened, how unforeseen it was for us and given my baby daughter was only one day old, I didn’t think I would ever come back from it,” he said.
Toni Evans, from Swansea, has seen first-hand the impact a mother and baby unit can have. She developed postpartum depression and psychosis after giving birth to her daughter in 2019. At the time, there were no units in her area, The Beeches, which is one of the most deprived in the UK, or even in the whole of Wales. She had to travel 180 miles away to Derbyshire to receive appropriate care, and believes if she had been unable to do that “100% I would not be here today”.
While she was lucky to obtain weekly perinatal mental health appointments, she rapidly deteriorated after her daughter’s birth and developed suicidal thoughts.
After a psychiatric evaluation Evans was placed in a mixed mental health unit in her local hospital, which she found a “scary” experience as she was separated from her daughter and surrounded by very unwell patients. “I didn’t feel like I belonged there. I felt I was already losing the bond with [my daughter] Sarah and I think us being separated made me deteriorate even further.”
She was sent 180 miles away to a mother and baby unit in Derbyshire, which she found “fantastic” and a more comfortable and accommodating environment.
However, travelling so far from home was upsetting: “I most remember going into that minibus and seeing my husband waving his newborn daughter and wife away and he was crying. That will stick with me for ever.”
She remained there for seven weeks, but said she would have “struggled more” had it happened during the cost of living crisis. “We’re not made of money, we get by OK, but my husband had to keep filling up the diesel every time he came up, and in seven weeks that’s a lot to get through. Derby were great in putting my husband up in a hotel, but he had to feed himself and my little boy, they had to pay for breakfast, lunch and dinner.”
Evans has since campaigned for a mother and baby unit to be opened in Wales, and there is now one at Tonna hospital in Swansea. “I hope there are no mothers who have to make that decision of going into another country, it adds a lot more pressure.”
Sarah*, from Glasgow, is lucky to have access to a mother and baby unit after she struggled with suicidal thoughts during her first pregnancy, but she is worried her financial situation will take a further toll on her mental health now that she is about to give birth to her second child.
“I’m on benefits because my mental health was so poor I couldn’t stick with a job, and I want to go back into training but I can’t because I have a child and I won’t be able to afford to do that. You’re trapped in this cycle and it’s really damaging,” she says.
She lives with her soon to be four-person family in a small two-bedroom housing association flat in central Glasgow, and dreams of having a garden to play in with her children, but she can’t afford private rentals. She can no longer afford her coping mechanisms, such as paying for the bus fare to enjoy green space.
“It’s quite terrifying how much your mental health can be affected when you’re pregnant. When my [first] wee girl was born I had images in my head of drowning her in the bath by accident, it was really awful, but it helped having people you felt you could talk to about that and get support,” she says.
Without that support she thinks “my life would be finished”. The team is monitoring her carefully, but she worries about going into hospital for treatment, as her husband would have to stop working to look after the children. “I feel there’s a bit of me that wouldn’t be as honest because I’m so determined to stay at home because I’m needed here so much.”
*name has been changed